Abstract

Vaccinations, nutritional and medical advances have increased the longevity of life—the proportion of octogenarians is expected to triple by 2050. This has opened a new chapter in clinical cardiology—angina management of the very elderly is now daily clinical fodder. Nearly a quarter of the patients presenting with acute coronary syndromes (ACS) and undergoing angiography will have diabetes mellitus (DM). With the advent of poor lifestyle choices such as unhealthy diets and reduction in exercise, DM is likely to increase further. Chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, is a recognized global health problem (Zimmet et al., Nat Rev Endocrinol 12:616–622, 2016) and is strongly associated with all-cause and cardiovascular mortality. In 2014 CKD was estimated to have a prevalence of 6.1% of the population in England and about 10% of the population in the USA. CKD is frequently encountered in ACS patients, with a prevalence of 30.5% in those presenting with an ST-elevation myocardial infarction and 42.9% with a non-ST-elevation myocardial infarction.

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